November, 2017 Laura’s Social Security Disability claim out of Roslindale, MA and Boston, MA hearing office

Laura contacted our office following her Social Security disability denial that she received out of the Roslindale, Massachusetts Social Security Administration (SSA) office. Unfortunately, Laura didn’t think about obtaining her own Social Security lawyer for her claim, thinking that she could handle matters on her own. As it turns out, because Laura was being paid long term disability benefits under a group policy through her employment with UNUM, she didn’t end up even having to pay attorney’s fees when she ultimately prevailed in her case.

Laura served many years at one of Boston’s most well-respected area hospitals as a patient care coordinator, ensuring that patients were receiving the appropriate care they needed. Unfortunately, Laura began experiencing quite serious back problems involving spinal stenosis that required her to undergo surgery (decompression surgery) to relieve the pressure in her spinal cord that was being placed on the nerves that run through her spinal canal . Consequently, she required a leave of absence from work under the Family Medical Leave Act, which entitled her initially to short term disability benefits and then, following three (3) months, she was placed on long term disability benefits (LTD) through UNUM.

The terms of the UNUM policy, under what is called a coordination of benefits provision, which is quite common for long term group disability policies, required that Laura apply for Social Security disability insurance (SSDI) benefits given the insurance carrier is entitled to an offset for such benefits. Thus, to the extent Laura receives Social Security disability insurance benefits in a given month, UNUM would be entitled to receive back dollar for dollar that which they have paid out. However, it’s important to understand that attorneys’ fees are typically deducted from the amount that is requested back given this is not actually money the individual receives (25% of the retroactive disability benefits is automatically set aside to pay the lawyer and the claimant never sees that money), and likewise with the understanding that this is a cost that was expended on their behalf so as to ensure they were reimbursed. Thus, in essence, the insurance carrier eats the cost of the attorney’s fees. For this reason, it is always in one’s best interest to hire their own lawyer to assist with a Social Security disability claim or appeal.

Because Laura did not have the advice of an attorney, she was pushed by UNUM to apply for Social Security disability benefits and did so after being out of work only four (4) months. Given the need to show she would likely be out of work for more than one (1) year (which Laura was not aware of), her denial was entirely expected and, likely, appropriate. We would have informed her that there is a high likelihood of denial if filing that early, and would have sought permission from UNUM to hold off on applying for some months down the road. Likewise, without the benefit of counsel, Laura was not aware of the fact that much of what we would obtain from her long term disability application file (including practitioner reports filled out by her providers to support her UNUM LTD claim) would ultimately serve to support her SSDI claim.

Indeed, upon retrieving very helpful material from her UNUM file and obtaining from her orthopedic surgeon a very helpful medical report, we were able to submit an argument brief to the presiding Administrative Law Judge (ALJ) at the hearing level (prior to the need to go to hearing) providing a much different picture of her case than that which appeared to SSA just four (4) months after going out of work. Given the brief and additional evidence provided, the ALJ provided her with an On the Record decision: that is, she did not have to go to a hearing and was provided with a fully favorable decision.

Certainly, Laura was happy as she not only didn’t have to go to hearing and won her case, but she also didn’t have to pay attorney’s fees out of her pocket. UNUM was likewise happy as they were able to reduce the amount they were paying Laura substantially given the offset provision to the policy, and likewise were paid back a substantial sum of money that has been previously paid out to Laura.

If you or someone you love has gone out on long term disability and is being pushed to apply for Social Security disability benefits, contact the Law Offices of Russell J. Goldsmith at (800) 773-8622 for guidance as to how to navigate these waters.